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Get CA BAR-115 2022-2024

0462 F 855 641-9982 www. bar. ca.gov Smog Check Technician Duplicate Wall License/Replacement Badge License Request Form Please complete this form if you require duplicate wall licenses or a replacement badge license. BUSINESS CONSUMER SERVICES AND HOUSING AGENCY GOVERNOR EDMUND G* BROWN JR* LICENSING UNIT 10949 North Mather Boulevard Rancho Cordova CA 95670 P 855 735. Each additional duplicate wall license requested in a single order is 2. 00 each. All orders will be sent to your address shown below. Note If you are requesting a replacement badge license you must sign and return the certification below with your request form* First Duplicate Wall License Additional Duplicate Wall Licenses x 2. 00 Replacement Badge License Wall and Badge License Package TOTAL Name Address 10. 00 Make company check cashier s check or money order payable to PSI. No personal checks or cash accepted* Send payment along with this form to PSI 3210 EAST TROPICANA LAS VEGAS NV 89121 To obtain a form to request a duplicate Adjuster or Station license see the BAR Web site www. bar. ca*gov or call 855 735-0462. I HEREBY CERTIFY under penalty of perjury under the laws of the State of California that I am the above technician requesting the duplicate license s. Each additional duplicate wall license requested in a single order is 2. 00 each. All orders will be sent to your address shown below. Note If you are requesting a replacement badge license you must sign and return the certification below with your request form* First Duplicate Wall License Additional Duplicate Wall Licenses x 2. Note If you are requesting a replacement badge license you must sign and return the certification below with your request form* First Duplicate Wall License Additional Duplicate Wall Licenses x 2. 00 Replacement Badge License Wall and Badge License Package TOTAL Name Address 10. 00 Make company check cashier s check or money order payable to PSI. 00 Replacement Badge License Wall and Badge License Package TOTAL Name Address 10. 00 Make company check cashier s check or money order payable to PSI. No personal checks or cash accepted* Send payment along with this form to PSI 3210 EAST TROPICANA LAS VEGAS NV 89121 To obtain a form to request a duplicate Adjuster or Station license see the BAR Web site www. No personal checks or cash accepted* Send payment along with this form to PSI 3210 EAST TROPICANA LAS VEGAS NV 89121 To obtain a form to request a duplicate Adjuster or Station license see the BAR Web site www. bar. ca*gov or call 855 735-0462. I HEREBY CERTIFY under penalty of perjury under the laws of the State of California that I am the above technician requesting the duplicate license s. Each additional duplicate wall license requested in a single order is 2. 00 each. All orders will be sent to your address shown below. Note If you are requesting a replacement badge license you must sign and return the certification below with your request form* First Duplicate Wall License Additional Duplicate Wall Licenses x 2. 00 Replacement Badge License Wall and Badge License Package TOTAL Name Address 10. 00 Make company check cashier s check or money order payable to PSI.

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